CN108430366A

CN108430366A - Apply the surgical instruments of electrosurgery and ultrasonic energy stage by stage

Info

Publication number: CN108430366A
Application number: CN201680076966.0A
Authority: CN
Inventors: K·L·豪泽
Original assignee: Angiotech Pharmaceuticals Inc
Current assignee: Angiotech Pharmaceuticals Inc
Priority date: 2015-12-30
Filing date: 2016-12-14
Publication date: 2018-08-21
Anticipated expiration: 2036-12-14
Also published as: MX2018008173A; US10470791B2; US20200046402A1; WO2017116696A1; JP6878442B2; US20170189093A1; MA43521A; BR112018013353A2; US11246622B2; JP2019502469A; CN108430366B; US20220104846A1; EP3397182A1; BR112018013353B1

Abstract

The invention discloses a kind of equipment, which includes main body, shaft assembly, end effector and control module.Shaft assembly extends from main body towards distal side, and includes acoustic waveguide.Waveguide is configured to couple with ultrasound transducer acoustic.End effector includes ultrasound knife, clamping limb, electrode and sensor.Ultrasound knife and waveguide acoustic connection.Clamping limb can operate so as to organize to compress against ultrasound knife.Electrode can be operated so that radio frequency (RF) electrosurgical energy is applied to tissue.Sensor can be operable to sense to the situation of the tissue contacted by end effector.Control module can be operated based on the data from sensor to control the conveying of ultrasonic power and RF electrosurgical energies by end effector.

Description

Apply the surgical instruments of electrosurgery and ultrasonic energy stage by stage

Background technology

A variety of surgical instruments include end effector, which has knife element, and the knife element is with supersonic frequency Vibration is to cut and/or seal tissue (for example, by making the protein denaturation in histocyte).These instruments include by electric power One or more piezoelectric elements of ultrasonic vibration are converted into, which is sent to knife element along acoustic waveguide.Cutting and The precision of condensation can be adjusted by the technology of operator and to power level, knife edge angle, tissue retraction power and knife pressure Control.For drive knife element power level can be based on such as tissue impedance, tissue temperature, tissue thickness and/or other The parameter of the sensing of factor and change (for example, in real time).Some instruments have clamping limb and gripper pad, for being grasped with knife element Tissue.

The example of ultrasonic surgical instrument includes HARMONICUltrasonic scissors, HARMONICUltrasound is cut Knife, HARMONICUltrasonic scissors and HARMONICUltrasound knife, above-mentioned whole instrument obtain KMS Medical LLC (Ethicon Endo-Surgery, Inc.of from the Ohio city of Cincinnati Cincinnati,Ohio).The other example and related notion of such device has disclosed in following patent：In June, 1994 Entitled " the Clamp Coagulator/Cutting System for Ultrasonic Surgical of publication on the 21st The United States Patent (USP) 5 of Instruments ", 322,055, the disclosure of which is herein incorporated by reference；2 months 1999 Entitled " the Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp of publication on the 23rd The United States Patent (USP) 5 of Mechanism ", 873,873, the disclosure of which is herein incorporated by reference；November 9 in 1999 Entitled " the Ultrasonic Clamp Coagulator Apparatus Having Improved Clamp of day publication The United States Patent (USP) 5 of Arm Pivot Mount ", 980,510, the disclosure of which is herein incorporated by reference；2001 Entitled " the Method of Balancing Asymmetric Ultrasonic Surgical Blades " of September publication on the 4th United States Patent (USP) 6,283,981, the disclosure of which is herein incorporated by reference；The name of publication on October 30th, 2001 The referred to as United States Patent (USP) 6 of " Curved Ultrasonic Blade having a Trapezoidal Cross Section ", 309,400, the disclosure of which is herein incorporated by reference；Entitled " the Blades of publication on December 4th, 2001 with Functional Balance Asymmetries for use with Ultrasonic Surgical The United States Patent (USP) 6 of Instruments ", 325,811, the disclosure of which is herein incorporated by reference；In July, 2002 Entitled " the Ultrasonic Surgical Blade with Improved Cutting and of publication on the 23rd The United States Patent (USP) 6 of Coagulation Features ", 423,082, the disclosure of which is herein incorporated by reference； Entitled " the Blades with Functional Balance Asymmetries for use of the publication on the 10th of August in 2004 The United States Patent (USP) 6 of with Ultrasonic Surgical Instruments ", 773,444, the disclosure of which is to draw It is incorporated herein with mode；Entitled " the Robotic Surgical Tool with of the publication on the 31st of August in 2004 The United States Patent (USP) 6 of Ultrasound Cauterizing and Cutting Instrument ", 783,524, the public affairs of the patent Content is opened to be herein incorporated by reference；Entitled " the Ultrasonic Surgical of publication on November 15th, 2011 The United States Patent (USP) 8 of Instrument Blades ", 057,498, the disclosure of which is herein incorporated by reference；2013 Entitled " the Rotating Transducer Mount for Ultrasonic Surgical of publication on June 11, in The United States Patent (USP) 8 of Instruments ", 461,744, the disclosure of which is herein incorporated by reference；In November, 2013 The United States Patent (USP) 8 of entitled " the Ultrasonic Surgical Instrument Blades " of publication on the 26th, 591,536, it should Disclosure is herein incorporated by reference；And entitled " the Ergonomic of publication on January 7th, 2014 The United States Patent (USP) 8 of Surgical Instruments ", 623,027, the disclosure of which is herein incorporated by reference.

The other example of ultrasonic surgical instrument has disclosed in following patent：The title that on April 13rd, 2006 announces 2006/ is announced for the U.S. of " Clamp pad for Use with an Ultrasonic Surgical Instrument " 0079874, the disclosure of which is herein incorporated by reference；August in 2007 is announced entitled on the 16th The U.S. of " Ultrasonic Device for Cutting and Coagulating " announces 2007/0191713, the patent Disclosure be herein incorporated by reference；Entitled " the Ultrasonic Waveguide that on December 6th, 2007 announces The U.S. of and Blade " announces 2007/0282333, and the disclosure of which is herein incorporated by reference；In August, 2008 It announces in the U.S. of entitled " the Ultrasonic Device for Cutting and Coagulating " announced on the 21st 2008/0200940, the disclosure of which is herein incorporated by reference；September in 2008 is announced entitled on the 25th The U.S. of " Ultrasonic Surgical Instruments " announces 2008/0234710, and the disclosure of which is to draw It is incorporated herein with mode；And entitled " the Ultrasonic Device forFingertip that on March 18th, 2010 announces The U.S. of Control " announces 2010/0069940, and the disclosure of which is herein incorporated by reference.

Some ultrasonic surgical instruments may include wireless energy converter such as disclosed in following patent：May 10 in 2012 The U.S. for entitled " the Recharge System for Medical Devices " that day announces announces 2012/0112687, should Disclosure is herein incorporated by reference；Entitled " the Surgical that on May 10th, 2012 announces The U.S. of Instrument with Charging Devices " announces 2012/0116265, and the disclosure of which is to draw It is incorporated herein with mode；And/or entitled " the Energy-Based Surgical that on November 5th, 2010 submits The U.S. Patent application 61/410,603 of Instruments ", the disclosure of which is herein incorporated by reference.

Additionally, some ultrasonic surgical instruments may include articulating shaft segment.The example of such ultrasonic surgical instrument exists Have in following patent disclosed：Entitled " the Surgical Instruments with that on January 2nd, 2014 announces The U.S. of Articulating Shafts " announces 2014/0005701, and the disclosure of which is incorporated by reference this Text；And entitled " the Flexible Harmonic Waveguides/Blades for that on April 24th, 2014 announces The U.S. of Surgical Instruments " announces 2014/0114334, and the disclosure of which is incorporated by reference this Text.

Some instruments can be operated with by the way that radio frequency (RF) electrosurgical energy is applied to tissue come seal tissue.It can grasp Make to be by the Ohio city of Cincinnati by the way that RF energy is applied to tissue come the example of the surgical instruments of seal tissue KMS Medical LLC (Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio) Tissue encapsulation device.The other example and related notion of such device has disclosed in following patent：December 31 in 2002 Entitled ", Electrosurgical Systems and Techniques for Sealing Tissue) " of day publication United States Patent (USP) 6,500,176, the disclosure of which is herein incorporated by reference；The title of the publication on the 26th of September in 2006 For the United States Patent (USP) 7 of " Electrosurgical Instrument and Method of Use ", 112,201, the patent Disclosure is herein incorporated by reference；Entitled " the Electrosurgical Working of publication on October 24th, 2006 The United States Patent (USP) 7 of End for Controlled Energy Delivery ", 125,409, the disclosure of which is to quote Mode is incorporated herein；Entitled " the Electrosurgical Probe and Method of of publication on January 30th, 2007 The United States Patent (USP) 7 of Use ", 169,146, the disclosure of which is herein incorporated by reference；Publication on March 6th, 2007 The U.S. of entitled " Electrosurgical Jaw Structure for Controlled Energy Delivery " is special Profit 7,186,253, the disclosure of which is herein incorporated by reference；On March 13rd, 2007 is issued entitled The United States Patent (USP) 7 of " Electrosurgical Instrument ", 189,233, the disclosure of which is by reference simultaneously Enter herein；Entitled " the Surgical Sealing Surfaces and Methods of of publication on May 22nd, 2007 The United States Patent (USP) 7 of Use ", 220,951, the disclosure of which is herein incorporated by reference；On December 18th, 2007 is issued Entitled " Polymer Compositions Exhibiting a PTC Property and Methods of The United States Patent (USP) 7 of Fabrication ", 309,849, the disclosure of which is herein incorporated by reference；In December, 2007 The United States Patent (USP) 7 of entitled " the Electrosurgical Instrument and Method of Use " of publication on the 25th, 311,709, the disclosure of which is herein incorporated by reference；On April 8th, 2008 is issued entitled The United States Patent (USP) 7 of " Electrosurgical Instrument and Method of Use ", 354,440, the public affairs of the patent Content is opened to be herein incorporated by reference；Entitled " the Electrosurgical Instrument " of publication on June 3rd, 2008 United States Patent (USP) 7,381,209, the disclosure of which is herein incorporated by reference.

Ultrasonic energy and radio frequency (RF) electrosurgical energy can be applied to tissue by some instruments.The example of such instrument exists It is described in following patent：Entitled " the Ultrasonic Surgical Instrument that on May 21st, 2015 announces The U.S. of with Electrosurgical Feature " announces 2015/0141981, and the disclosure of which is with the side of reference Formula is incorporated herein；And entitled " the Ultrasonic Electrosurgical of publication on March 4th, 2014 The United States Patent (USP) 8 of Instruments ", 663,220, the disclosure of which is herein incorporated by reference.

Although having made and having used several surgical instruments and system, it is believed that before the present inventor it is unmanned make or Use the present invention described in appended claims.

Description of the drawings

Although this specification has obtained the claim for particularly pointing out and realizingly stating this technology, evidence Certain examples that believer in a certain religion describes below in conjunction with attached drawing are better understood with this technology, wherein similar reference numeral mark is identical Element, and wherein：

Fig. 1 depicts the block diagram of exemplary surgical system；

Fig. 2 depicts the side front view of the exemplary surgical instrument in the system that may be incorporated into Fig. 1；

Fig. 3 is depicted at the cross-sectional side view of the end effector of the instrument of Fig. 2 of closed position；

Fig. 4 is depicted at the cross-sectional side view of the end effector of Fig. 3 of open position；

Fig. 5, which is depicted, shows that tissue temperature is to the curve graph of the curve of time during the enabling of the end effector of Fig. 3；

Fig. 6 depicts the signal for the exemplary arrangement for being powered component that can be provided in the modified version of the instrument of Fig. 2 Figure；

Fig. 7 is depicted in the instrument for may be incorporated into Fig. 2 to provide the exemplary alternative end of the arrangement for being powered component of Fig. 6 The perspective view of actuator；

Fig. 8 depicts the cross sectional end view of the end effector of Fig. 7 of clamping tissue；

Fig. 9 depicts alternative to provide the another exemplary of the arrangement for being powered component of Fig. 6 in the instrument for may be incorporated into Fig. 2 The perspective view of end effector；

Figure 10 depicts the cross sectional end view of the end effector of Fig. 9 of clamping tissue；

Figure 11 depicts the curve for the exemplary enabling scheme for showing can be used the arrangement for being powered component of Fig. 6 to complete Figure；

Figure 12, which is depicted, shows that tissue temperature is to the curve graph of the curve of time during the execution of the enabling scheme of Figure 11；

Figure 13 depicts the song that the exemplary alternative for showing can be used the arrangement for being powered component of Fig. 6 to complete enables scheme Line chart；And

Figure 14 depicts the another exemplary for showing can be used the arrangement for being powered component of Fig. 6 to complete and optionally enables scheme Curve graph.

Attached drawing is not intended to be limited in any way, and it is contemplated that the various embodiments of this technology can be more Other modes are planted to complete, various other modes include the mode that those may not describe in the accompanying drawings.Be incorporated in this specification and The attached drawing for forming the part of this specification shows several aspects of this technology, and is used to explain this technology together with the description Principle；It will be appreciated, however, that this technology is not limited to shown accurate arrangement.

Specific implementation mode

Below certain exemplary descriptions of this technology are not applied to the range of limitation this technology.From description below, originally Other examples, feature, aspect, embodiment and the advantage of technology will become obvious to those skilled in the art, Description below carries out by way of illustration, this is the one mode to complete in the best mode contemplated by this technology.As It will be realized that, the techniques described herein can have other different and apparent aspects, all such aspects all without departing from This technology.Then, attached drawing and description should be considered as substantially being illustrative rather than limited.

Also, it is understood that any of teachings described herein content, expression way, embodiment, example etc. Or more persons can be with any one or more of other teachings as described herein, expression way, embodiment, example etc. group It closes.Thus, following teachings, expression way, embodiment, example etc. are it is not considered that be isolated from each other.With reference to teaching herein Content, the various suitable methods that teaching herein content can be combined will be easy for the ordinary skill in the art Ground is apparent.Such modifications and variations are intended to be included in the range of claims.

For it is disclosed it is clear for the sake of, term " nearside " and " distal side " are herein for relative to grasping with distal side surgery end What the operator of the surgical instruments of portion's actuator or other operators defined.Term " nearside " be finger element closer to operator or The position of other operators, and term " distal side " be finger element closer to the surgical end-effector of surgical instruments and further from The position of operator or other operators.

I. the general introduction of exemplary ultrasonic system

Fig. 1 shows the component of exemplary surgical system (10) in the form of illustrating frame.As shown, system (10) includes Ultrasonic generator (12) and ultrasonic surgical instrument (20).It is such as described more detail above, instrument (20) can be operated with substantially Tissue is cut using ultrasonic vibrational energy and seal or weld tissue (for example, blood vessel etc.) simultaneously.Generator (12) and instrument (20) it is linked together via cable (14).Cable (14) may include a plurality of wire rod；And it can provide from generator (12) to device The unidirectional electric connection of tool (20), and/or provide two-way electric connection between generator (12) and instrument (20).Only with citing Mode, cable (14) may include：" heat " line for providing from electric power to surgical instruments (20)；Ground wire；And it is used for signal The signal wire of ultrasonic generator (12) is transferred to from surgical instruments (20), wherein cover surrounds three lines.It is single in some patterns For individually enabling voltage, (for example, " heat " line enables voltage for first, another " heat " line is used for the to only " heat " line Two enable the variable voltage etc. between voltage, or the line proportional to required power).Certainly, it can be used any other suitable The line of quantity or configuration.It will also be understood that generator (12) can be incorporated in instrument (20) by some patterns of system (10) so that Cable (14) can simply leave out.

Only by way of example, generator (12) may include treasuring health endoscopic surgery public affairs by the Ohio city of Cincinnati Take charge of GEN04, GEN11 or GEN 300 that (Ethicon Endo-Surgery, Inc., of Cincinnati, Ohio) is sold.This Outside or in alternative arrangement, generator (12) can be constructed according at least some of the teachings of following patent：2011 Entitled " the Surgical Generator for Ultrasonic and Electrosurgical that on April 14, in announces The U.S. of Devices " announces 2011/0087212, and the disclosure of which is herein incorporated by reference.Alternatively, can make With any other suitable generator (12).As will be described in more detail below, generator (12) can be operated with by power Instrument (20) is provided, to execute ultrasonic surgical.

Instrument (20) includes handle assembly (22), which is configured to be grabbed during surgery It is held in the hand (or two hands) of operator, and is manipulated by the hand of operator (or two hands).For example, at some In pattern, handle assembly (22) can be grasped as pencil by operator.In some other patterns, handle assembly (22) can wrap Include the scissor grip part that can be grasped by operator as scissors.In some other patterns, handle assembly (22) may include The pistol grip that can be grasped by operator as pistol.Certainly, handle assembly (22) is configured to any Other suitable modes are held.In addition, some pattern available bodies of instrument (20) replace handle assembly (22), the main body It is connected to the robotic surgical system for being configured to operation instrument (20) (for example, via remote control etc.).In this example In, knife (24) extends from handle assembly (22) towards distal side.Handle assembly (22) includes that ultrasonic transducer (26) and connection ultrasound are changed The ultrasound waveguide (28) of energy device (26) and knife (24).Ultrasonic transducer (26) receives electricity via cable (14) from generator (12) Power.Due to its piezoelectric properties, thus ultrasonic transducer (26) can operate using by such electrical power conversion as ultrasonic vibrational energy.

Ultrasound waveguide (28) can be flexible, semiflexible, rigid, or have any other suitable attribute.Such as Above-mentioned, ultrasonic transducer (26) is integrally coupled via ultrasound waveguide (28) and knife (24).Specifically, work as ultrasonic transduction When device (26) is activated with ultrasonic frequency vibratory, such vibration is sent to knife (24) by ultrasound waveguide (28) so that knife It (24) also will be with ultrasonic frequency vibratory.When knife 24) in enabling, (when state (that is, ultrasonic vibration), knife (24) can be operated to have Cut through tissue, and seal tissue to effect.Therefore, when being powered by generator (12), ultrasonic transducer (26), ultrasound waveguide (28) and knife (24) is formed as the acoustic assembly that surgical operation provides ultrasonic energy together.Handle assembly (22) is configured to Make the vibration substantial barrier of operator and the acoustic assembly formed by energy converter (26), ultrasound waveguide (28) and knife (24).

In some patterns, ultrasound waveguide (28), which can amplify, to be transmitted to the machinery of knife (24) by ultrasound waveguide (28) and shakes It is dynamic.Ultrasound waveguide (28) can also have the features of the gain of extensional vibration of the control along ultrasound waveguide (28) and/or incite somebody to action Ultrasound waveguide (28) be tuned to system (10) resonant frequency features.For example, ultrasound waveguide (28) can be with any suitable Cross sectional dimensions/configuration, it is such as substantially uniform cross section, tapered, tapered along its whole length at various sections, Or there is any other suitable configuration.The length of ultrasound waveguide (28) can for example be substantially equal to system wavelength two/ One integral multiple (λ/2 n).Ultrasound waveguide (28) and knife (24) can be prepared by solid shaft, and the solid shaft is by effectively propagating ultrasound The combination of the material or multiple material of energy is constructed, such as titanium alloy (that is, Ti-6Al-4V), aluminium alloy, sapphire, no The combination of rust steel or any other acoustics compatible material or material.

In this example, the distal end of knife (24) is positioned corresponding to vibrate with the resonant ultrasonic transmitted by waveguide (28) At the position of associated antinode (that is, at acoustics antinode), so as to when acoustic assembly is not loaded by tissue by acoustic assembly tune It is humorous to arrive preferred resonant frequency f_o.When energy converter (26) are powered, the distal end of knife (24) is configured to for example big In about 10 microns to 500 microns peak-to-peak ranges and in some cases in about 20 microns to about 200 microns of range with example Such as the scheduled vibration frequency f of 55.5kHz_oLongitudinal movement.When this exemplary energy converter (26) is activated, these mechanical oscillations are logical It crosses waveguide (28) to transmit to reach knife (24), thus oscillation of the knife (24) under resonant ultrasonic frequency is provided.Therefore, knife (24) Sonic oscillation can cut off tissue and make the protein denaturation in adjacent tissue's cell simultaneously, and thus providing has relatively fewer heat The rush of diffusion coagulates effect.In some patterns, also electric current can be provided by knife (24), with other burning tissue.

Only by way of example, ultrasound waveguide (28) and knife (24) may include treasuring health by the Ohio city of Cincinnati Endoscopic surgery company (Ethicon Endo-Surgery, Inc.of Cincinnati, Ohio) with product coding SNGHK and The component that SNGCB is sold.In addition only by way of example, ultrasound waveguide 28 and/or knife 24 can be issued according on July 23rd, 2002 Entitled " Ultrasonic Surgical Blade with Improved Cutting and Coagulation The teachings of the United States Patent (USP) 6,423,082 of Features " are constructed and are operated, and the disclosure of which is by reference It is incorporated herein.It is merely illustrative example as another, ultrasound waveguide (28) and/or knife (24) can be according to June 28 in 1994 The United States Patent (USP) of entitled " the Ultrasonic Scalpel Blade and Methods of Application " of day publication 5,324,299 introduction construction and operation, the disclosure of which is herein incorporated by reference.With reference in teaching herein Hold, other suitable attributes and configuration of ultrasound waveguide (28) and knife (24) will be for the ordinary skill in the art Obviously.

This exemplary handle assembly (22) also includes that control selections device (30) and enabling switch (32), each and circuit Plate (34) is connected to.Only by way of example, circuit board (34) may include conventional printed circuit boards, flexible circuit, hard and soft circuit, Or there can be any other suitable configuration.Control selections device (30) and enable switch (32) can via one or more line, It the trace that is formed in circuit board or flexible circuit and/or is connected in any other suitable manner with circuit board (34).Circuit Plate (34) couples with cable (14), which then couples with the control circuit (16) in generator (12).Enable switch (32) it can operate to be selectively enabled to the power of ultrasonic transducer (26).Specifically, when switch (32) is activated, this Class enables to provide is sent to ultrasonic transducer (26) via cable (14) by power appropriate.Only by way of example, enabling is opened Closing (32) can construct according to any one of teachings for the various bibliography quoted from herein.With reference in teaching herein Hold, it will be apparent for the ordinary skill in the art to enable switch (32) other adoptable various forms 's.

In this example, surgery system (10) can be operated to provide at least two different levels or type at knife (24) Ultrasonic energy (for example, different frequency and/or amplitude etc.).For this purpose, control selections device (30) can be operated to permit operator Select the ultrasonic energy of aspiration level/amplitude.Only by way of example, control selections device (30) can be various according to what is quoted from herein Any one of teachings of bibliography construct.With reference to teaching herein content, control selections device (30) is adoptable Other various forms will be obvious to those of ordinary skill in the art.In some patterns, work as operator When being selected by control selections device (30), the selection of operator is transferred back to the control of generator (12) via cable (14) Circuit (16), and then operator activates enabling switch (32) next time, and control circuit (16) adjustment is transmitted from generator (12) Power.

It should be appreciated that level/amplitude of the ultrasonic energy provided at knife (24) may depend on from generator (12) via cable Line (14) is transmitted to the characteristic of the electric power of instrument (20).Therefore, the control circuit (16) of generator (12) can be (via cable (14)) electric power is provided, which has related to the ultrasound energy level/amplitude or type selected by control selections device (30) The characteristic of connection.Therefore, according to the selection carried out via control selections device (30) by operator, generator (12) can be operated to incite somebody to action The power transmission of different type or degree is to ultrasonic transducer (26).Specifically, and only by way of example, generator (12) The voltage and or current that applied signal can be increased, to increase the pitch amplitude of acoustic assembly.As merely exemplary example, Generator (12) may be provided in the alternative between " level 1 " and " level 5 ", they can correspond respectively to about 50 microns and The vibration resonance amplitude of about 90 microns of knife (24).With reference to teaching herein content, the various of control circuit (16) are can configure Mode will be obvious to those of ordinary skill in the art.It will also be understood that control selections device (30) and opening It can be replaced with two or more enabling switches (32) with switch (32).In some such patterns, one enables switch (32) can operate under a power level/type enable knife (24), and another enablings switch (32) can operate with Knife (24) is enabled under another power level/type, etc..

In some select pattern else, control circuit (16) is located in handle assembly (22).For example, in some such patterns In, a type of electric power (for example, obtainable only one voltage and or current) is only transmitted to shank group by generator (12) Part (22), and the control circuit (16) in handle assembly (22) can be operated with basis by operator via control selections device (30) electric power (for example, voltage of electric power) is changed in the selection carried out before electric power reaches ultrasonic transducer (26).In addition, occurring The every other component of device (12) and surgery system (10) may be incorporated into handle assembly (22).For example, one or more battery (not shown) or other portable powers may be provided in handle assembly (22).With reference to teaching herein content, described in Fig. 1 Component can be re-arranged or other suitable methods for otherwise constructing or changing for this field ordinary skill people It will be apparent for member.

II. the general introduction of Exemplary ultrasonic surgical instruments

Following discussion is related to the various example components and configuration of instrument (20).It should be appreciated that instrument described below (20) various examples can be easily incorporated into surgery system as described above (10).It will also be understood that device described above The various parts and operability of tool (20) can be easily incorporated into the exemplary version of instrument described below (20).With reference to Teaching herein content, the various suitable methods that teachings can combine above and below are for those of ordinary skill in the art For will be apparent.It will also be understood that teachings can be easily various with the bibliography quoted from herein below Teachings combine.

Fig. 2 to Fig. 4 shows Exemplary ultrasonic surgical instruments (100).At least part of instrument (100) can be according to following At least some of teachings of patent are constructed and are operated：United States Patent (USP) 5,322,055；United States Patent (USP) 5,873,873； United States Patent (USP) 5,980,510；United States Patent (USP) 6,325,811；United States Patent (USP) 6,773,444；United States Patent (USP) 6,783,524；The U.S. Patent 8,461,744；United States Patent (USP) 8,623,027；Announce 2006/0079874 in the U.S.；Announce 2007/0191713 in the U.S.；It is beautiful State announces 2007/0282333；Announce 2008/0200940 in the U.S.；Announce 2010/0069940 in the U.S.；Announce 2012/ in the U.S. 0112687；Announce 2012/0116265 in the U.S.；Announce 2014/0005701 in the U.S.；Announce 2014/0114334 in the U.S.；The U.S. is special Profit application 61/410,603；And/or U.S. Patent application 14/028,717.It is public in each of aforementioned patent, announcement and application Content is opened to be herein incorporated by reference.It is as described herein and such as will be described in further detail below, instrument (100) can operate with It substantially simultaneously cuts tissue and seals or weld tissue (for example, blood vessel etc.).It will also be understood that instrument (100) can with it is following Instrument has various structure and function similitudes：HARMONICUltrasonic scissors, HARMONICUltrasound is cut Knife, HARMONICUltrasonic scissors, and/or HARMONICUltrasound knife.In addition, instrument (100) The device that can be instructed with any of other bibliography quoted from and be herein incorporated by reference herein has Various structure and function similitudes.

Bibliography, the HARMONIC just quoted from hereinUltrasonic scissors, HARMONICUltrasound is cut Knife, HARMONICUltrasonic scissors, and/or HARMONICThe teachings of ultrasound knife with Under be related between the teachings of instrument 100 for the overlapping of existing certain degree, be not intended to any description of this paper It is assumed to the generally acknowledged prior art.Several teachings herein are in fact by the introduction beyond the bibliography quoted from herein Content and HARMONICUltrasonic scissors, HARMONICUltrasonic scissors, HARMONICIt is super Sound scissors and HARMONICThe range of ultrasound knife.

This exemplary instrument (100) includes handle assembly (120), shaft assembly (130) and end effector (140).Shank Component (120) includes main body (122), which includes pistol grip (124) and a pair of buttons (126).Shank group Part (120) also includes trigger (128), which can pivot toward and away from pistol grip (124).However, It should be appreciated that various other suitable configurations, including but not limited to pencil formula grip part configuration or scissor grip part can be used Configuration.End effector (140) includes ultrasound knife (160) and pivot clamping limb (144).Clamping limb (144) and trigger (128) Connection so that clamping limb (144) in response to trigger (128) towards the pivot of pistol grip (124), can be towards ultrasound knife (160) it pivots；And make clamping limb (144) may be in response to trigger (128) far from pistol grip (124) pivot and It is pivoted far from ultrasound knife (160).With reference to teaching herein content, clamping limb (144) can be coupled with trigger (128) various Suitable mode will be obvious to those of ordinary skill in the art.In some patterns, using one or Multiple elastic components make the clamping limb (144) and/or trigger (128) be biased to open position shown in Fig. 4.

Ultrasound transducer assembly (112) is extended proximally from the main body (122) of handle assembly (120).Transducer assemblies (112) couple with generator (116) via cable (114).Transducer assemblies (112) receive electric power from generator (116), and By piezoelectric principle by electrical power conversion at ultrasonic vibration.Generator (116) may include power supply and control module, control module by with Being set to can will provide particularly suitable for generating the power distribution of ultrasonic vibration by transducer assemblies (112) to transducer assemblies (112).Only by way of example, generator (116) may include treasuring health endoscopic surgery public affairs by the Ohio city of Cincinnati Take charge of GEN04, GEN11 or GEN 300 that (Ethicon Endo-Surgery, Inc.of Cincinnati, Ohio) is sold.This Outside or in alternative arrangement, generator (116) can be configured according at least some of the teachings of following patent：2011 Entitled " the Surgical Generator for Ultrasonic and Electrosurgical that on April 14, in announces The U.S. of Devices " announces 2011/0087212, and the disclosure of which is herein incorporated by reference.It will also be understood that At least some of the function of generator (116) can be integrated into handle assembly (120), and handle assembly (120) or even can Including battery or other board mounted powers so that cable (114) is removed.With reference to teaching herein content, generator (116) can be adopted Other suitable forms and the available various features of generator (116) and operability are for the common of this field It will be apparent for technical staff.

This exemplary knife (160) is operable to ultrasonic frequency vibratory, effectively to cut through tissue and seal tissue, Especially when tissue is held between clamping limb (144) and knife (160).Knife (160) is positioned in the remote of acoustics power train At side end.Acoustics power train includes transducer assemblies (112) and acoustic waveguide (102).Transducer assemblies (112) include being located at just One group of piezo disc (not shown) of the soldering tip (not shown) nearside of property acoustic waveguide (102).Piezo disc can be operated with will be electric Power is converted into ultrasonic vibration, and the ultrasonic vibration is then according to known configuration and technology along extending through shaft assembly (130) Acoustic waveguide (102) is transmitted to knife (160).Only by way of example, the part of acoustics power train can be each according to what is quoted from herein The various teachings of kind bibliography are constructed.

Waveguide (102) is fixed on via the pin (133) across waveguide (102) and shaft assembly (130) in shaft assembly (130). (133) are sold positioned at the length node pair associated with the resonant ultrasonic vibration transmitted by waveguide (102) along waveguide (102) At the position answered.When ultrasound knife (160) is in enabling state (that is, ultrasonic vibration), ultrasound knife (160) is operable with effectively Simultaneously seal tissue is cut through, especially when tissue is just being clamped between clamping limb (144) and ultrasound knife (160).It should be appreciated that wave It leads (102) and is configured to the mechanical oscillation that amplification is transmitted by waveguide (102).In addition, may include can for waveguide (102) Operation is to control the features of the gain of the extensional vibration along waveguide (102) and/or for waveguide (102) to be tuned as system Resonant frequency features.

In this example, the distal end of knife (160) is located at related to the resonant ultrasonic vibration transmitted by waveguide (102) At the corresponding position of antinode of connection, so as to when acoustic assembly is not loaded by tissue by acoustic assembly be tuned to preferred resonance frequency Rate f_o.When transducer assemblies (112) are powered, the distal end of knife (160) is configured at such as about 10 microns extremely In 500 microns of peak-to-peak ranges and in some cases in about 20 microns to about 200 microns of range with such as 50kHz or The scheduled vibration frequency f of 55.5kHz_oLongitudinal movement.When this exemplary transducer assemblies (112) is activated, these machineries shake It swings to transmit by waveguide (102) and reaches knife (160), thus oscillation of the knife (160) under resonant ultrasonic frequency is provided.Therefore, when When tissue is fixed between knife (160) and clamping limb (144), the sonic oscillation of knife (160) can cut off tissue simultaneously and make Thus albuminous degeneration in adjacent tissue cell provides the rush with relatively small number of thermal diffusion and coagulates effect.In some patterns, Also electric current can be provided by knife (160) and clamping limb (144), with other burning tissue.Although it have been described that acoustics transmission group Some configurations of part and transducer assemblies (112), but teaching herein content is referred to, it is used for acoustics transmitting assembly and energy converter group Other suitable configurations of part (112) will be obvious to those of ordinary skill in the art.Similarly, with reference to this The teachings of text, other suitable configurations for end effector (140) for the ordinary skill in the art will It is obvious.

Operator can enable button (126) and enable knife (160) to be selectively enabled transducer assemblies (112).At this In example, (126)-one buttons of two buttons are provided for enabling the knife (160) under low-power, and another button is used for Enable the knife (160) under high power.It will be appreciated, however, that any other appropriate number of button can be provided and/or with other sides The optional power level of formula.Such as, it is possible to provide floor push is to be selectively enabled transducer assemblies (112).Originally exemplary to press Button (126) is positioned such that operator can easily use one-handed performance instrument (100) completely.For example, operator can be by its thumb Its middle finger, the third finger and/or little finger of toe are located in around trigger (128) by specific bit around pistol grip (124), And carry out control button (126) using its index finger.Certainly, any other suitable technology can be used to hold and operate instrument (100)；And button (126) can be located at any other suitable position.

This exemplary shaft assembly (130) includes external jacket (132), is arranged on external jacket in a manner of it can slide (132) waveguide (102) of inner tube (134) and setting in inner tube (134) in.As will be discussed in more detail below, interior Pipe (134) can operate with relative to external jacket (132) in external jacket (132) interior longitudinal translation, with selectively direction Clamping limb (144) is pivoted with far from knife (160).This exemplary shaft assembly (130) further includes rotary components (150).Rotary components (150) it can operate so that entire shaft assembly (130) and end effector (140) surround the longitudinal axis phase of shaft assembly (130) Handle assembly (120) are rotated.In some patterns, rotary components (150) can be operated selectively to lock shaft assembly (130) and end effector (140) surrounds Angle Position of the longitudinal axis of shaft assembly (130) relative to handle assembly (120).Example Such as, the knob (152) of rotary components (150) can translate between first longitudinal direction position and second longitudinal direction position, in first longitudinal direction In position, shaft assembly (130) and end effector (140) can surround the longitudinal axis of shaft assembly (130) relative to handle assembly (120) it rotates；In second longitudinal direction position, shaft assembly (130) and end effector (140) can not surround shaft assembly (130) Longitudinal axis is rotated relative to handle assembly (120).Certainly, in addition to or substitute those discussed above in any one, shaft assembly 130 can have various other components, features and operability.With reference to teaching herein content, other of shaft assembly 130 are suitable Configuration will be obvious to those of ordinary skill in the art.

As shown in Figure 3 and Figure 4, end effector (140) includes ultrasound knife (160) and clamping limb (144).Clamping limb (144) include gripper pad (146), downside of the gripper pad (146) towards knife (160), fixed to clamping limb (144).Only to lift The mode of example, gripper pad (146) can be formed by polytetrafluoroethylene (PTFE) (PTFE) material and/or any other suitable material.In addition only By way of example, gripper pad (146) can also construct configuration and behaviour according at least some of teachings of following patent Make：Entitled " the Combination Tissue Pad for Use with an Ultrasonic of publication on June 9th, 2009 The United States Patent (USP) 7 of Surgical Instrument ", 544,200, the disclosure of which is herein incorporated by reference.

Clamping limb (144) via pin (145) with can pivotably with the shaft assembly in ultrasound knife (160) above (130) distal end of external jacket (132) couples.Seen in best as in Fig. 4, the distal end of inner tube (134) via Pin (135) is coupled in a manner of it can rotate with the proximal end of the clamping limb (144) in ultrasound knife (160) below so that interior The longitudinal translation of pipe (134) causes rotation of the clamping limb (144) around pin (145) toward and away from ultrasound knife (160), thus will Tissue is clamped between clamping limb (144) and ultrasound knife (160) with cutting and/or seal tissue.Specifically, inner tube (134) phase Cause clamping limb (144) towards ultrasound knife (160) the nearside longitudinal translation of external jacket (132) and handle assembly (120) It is mobile；And inner tube (134) causes clamping limb relative to the distal side longitudinal translation of external jacket (132) and handle assembly (120) (144) mobile far from ultrasound knife (160).

In this example, trigger (128) to be can be pivotally coupled to handle assembly (120), and also with it is interior Manage (134) connection.Specifically, the pivot of trigger (128) towards pistol grip (124) will cause inner tube (134) opposite In the nearside longitudinal translation of external jacket (132) and handle assembly (120).Trigger (128) is far from pistol grip (124) Pivot inner tube (134) will be caused relative to the distal side longitudinal translation of external jacket (132) and handle assembly (120).Finally, because Cause clamping limb (144) to be rotated toward and away from knife (160) for the longitudinal translation of inner tube (134), as discussed above, should manage The pivot of solution, trigger (128) towards pistol grip (124) will cause clamping limb (144) to be moved towards ultrasound knife (160) It is dynamic；And pivot of the trigger (128) far from pistol grip (124) will cause clamping limb (144) far from ultrasound knife (160) It is mobile.It is publicly available in coupling trigger (128) to provide this with inner tube (134) in several bibliography quoted from herein The various suitable components and features of operation.With reference to teaching herein content, can be used for trigger (128) and inner tube (134) coupling other suitable components and features to provide the operation will be for the ordinary skill in the art Obviously.It will also be understood that in some variations, trigger (128) can be operated in inner tube (134) remains stationary Zigzag tread patterns external jacket (132).In this type formula, external jacket (132) will similarly relative to the translation of inner tube (134) Clamping limb (144) is caused to be pivoted toward and away from ultrasound knife (160).

Fig. 5 is shown is clamped in the drafting tissue temperature time course between clamping limb (144) and knife (160) Nei in tissue The exemplary graph (200) of (202) is spent, wherein knife (160) is enabled by ultrasound.Group is worked as in the origin expression of the curve graph (200) It knits at the time of be clamped in when between clamping limb (144) and knife (160) knife (160) and enabled by ultrasound.Line (204) indicate in response to by The ultrasonic energy that knife (160) applies, tissue will start the temperature levels of sealing.Similarly, line (206) is indicated in response to by knife (160) the ultrasonic energy tissue applied starts the time of sealing.Line (208) indicates the time that the sealing of tissue terminates.Thus, it answers Work as understanding, the distance between line (206,208) indicates the duration that tissue is sealed by end effector (140).

It will also be understood that in this example, during the duration indicated by the spacing between line (206,208), group The temperature knitted continues to increase.In some select pattern else, end effector (140) may include sensing function so that end executes Device (140) can during sealing acts (that is, in online duration indicated between (206) and line (208)) by tissue temperature Degree (202) is maintained essentially at level associated with line (204).In other words, sensing function can prevent tissue overheating.It can root Such sensing is provided according to the teachings for the one or more bibliography quoted from herein.

It will also be understood that the temperature no matter organized was continued in the online duration indicated between (206) and line (208) Increase is also to maintain general planar, once it is determined that tissue has reached sealing state appropriate (that is, being indicated by line (208) Moment), such sensing just can be used for going automatically enabling knife (160).It equally, can be one or more with reference to text according to what is quoted from herein The introduction offered provides such sensing and response.

In addition or in alternative arrangement, operator can rely on the visual observation and/or touch feedback by trigger (128) (for example, feeling difference of the chucking power from clamping limb (144)) determines when tissue has reached appropriate sealing state.Operation Then person can discharge actuating button (126) to go to enable knife (160), and discharge trigger (128) so that clamping limb (144) is remote It is pivoted from tissue, thus establishes the end in the sealing stage indicated by line (208) manually).

The above-mentioned parts and operability of instrument (100) are only illustrative.Teaching herein content is such as referred to for this It will be apparent for the those of ordinary skill in field, instrument (100) can be constructed in many other ways.Only to lift The mode of example, at least part of instrument (100) can be according at least some of the teachings of any one of following patent Teachings are constructed and/or are operated, and disclosures of these patents are herein incorporated by reference：United States Patent (USP) 5,322, 055；United States Patent (USP) 5,873,873；United States Patent (USP) 5,980,510；United States Patent (USP) 6,325,811；United States Patent (USP) 6,783,524； Announce 2006/0079874 in the U.S.；Announce 2007/0191713 in the U.S.；Announce 2007/0282333 in the U.S.；Announce 2008/ in the U.S. 0200940；Announce 2010/0069940 in the U.S.；Announce 2011/0015660 in the U.S.；Announce 2012/0112687 in the U.S.；The U.S. is public Cloth 2012/0116265；Announce 2014/0005701 in the U.S.；And/or the U.S. announces 2014/0114334.It will in further detail below Additional only illustrative modification of the ground description for instrument (100).It should be appreciated that modification described below is readily applicable to Any instrument, etc. involved in any bibliography recited in above-mentioned instrument (100) and this paper.

III. the exemplary end effector with combined ultrasonic and electrosurgery ability

Using conventionally form instrument (20,100) some cases under, when tissue be clamped in clamping limb (144) and When between knife (160), tissue can take an undesirably long time to reach the temperature that the enabling tissue in response to knife (160) starts sealing Degree.In other words, referring again to Fig. 5, at the time of expression at the time of knife (160) is activated and by line (206) between continue Time can be relatively long.Thus, it may be desirable to accelerating should " preheating " time.As described in more detail below, can accelerate " preheating " A kind of mode of time is that RF electrosurgical energies are applied to tissue.As it is following also will be described in more detail, can be used will be ultrasonic The same end actuator that energy is applied to tissue applies the RF electrosurgical energies.In addition to providing RF electrosurgeries and ultrasound energy General combination is outer, and example below additionally provides control algolithm, which adjusts the application of both different-energy forms To avoid making tissue overheating.Therefore following example provides the warm-up ability of enhancing and is overheated without causing.

Fig. 6 shows the arrangement of the component of the system of can be used to form (250), which is capable of providing the group of enhancing Warm-up ability is knitted without leading to tissue overheating.It should be appreciated that the system (250) component and operability can easily with it is above-mentioned The component and operability of system (10) combine.The exemplary system (250) includes power supply (252), control module (256), sound Learn power train (258), RF electrosurgeries power train (260) and sensor (262).

This exemplary power supply (252) can operate drives acoustics power train (258) and RF electrosurgeries to pass to provide electric power Dynamic system (260).Power supply (252) can also be operated to provide required any electric power, so that control module (256) can be grasped Make.Only by way of example, power supply (252) may include such as above-mentioned generator (12,116) of generator.Such as in addition description above , power supply (252) can be integrated into surgical instruments associated with system (250) or power supply (252) can be all via cable Such as cable (14,114) couples with surgical instruments.With reference to teaching herein content, the adoptable various suitable shapes of power supply (252) Formula will be obvious to those of ordinary skill in the art.

This exemplary control module (256) may include the microprocessor for being configured as executing control logic and/or it is various its His hardware component.Specifically, according to the one or more control algolithms provided by control logic, control module (256) can Operation is provided with the power that will selectively come from power supply (252) to acoustics power train (258) and RF electrosurgery power trains (260).In there are the pattern of sensor (262), control module (256) from sensor (262) receive data, and thus when It can be operated when executing control logic to take into account such data.In some patterns, control module (256) is integrated into In power supply (252) (for example, in generator (12,116) of surgical instruments associated with system (250) separation)).At some In other patterns, control module (256) is integrated into surgical instruments associated with system (250).With reference to teaching herein Content, the adoptable various suitable forms of control module (256) will be for the ordinary skill in the art it is aobvious and It is clear to.

As adjusted by control module (256), this exemplary acoustics power train (258) is in response to coming from power supply (252) Electric power can be operated to generate and transmit ultrasonic vibration.Only by way of example, acoustics power train (258) may include institute as above Ultrasonic transducer (26,112), waveguide (28) and the ultrasound knife (24,160) stated.With reference to teaching herein content, acoustics power train (258) other adoptable suitable forms will be obvious to those of ordinary skill in the art.

As adjusted by control module (256), this exemplary RF electrosurgeries power train (260) is in response to coming from power supply (252) electric power can be operated so that RF electrosurgical energies are applied to tissue.Only by way of example, RF electrosurgeries power train (260) it may include a pair of electrodes and corresponding a pair of of the cable (for example, wire rod, trace etc.) coupled with control module (256).Such as It is described more fully below, the electrode of RF electrosurgeries power train (260) can be integrated into phase with the ultrasound knife of acoustics power train (258) In same end effector.For example, clamping limb (such as clamping limb (144)) may include that each electrode offer of two electrodes-is used for Apply the different extremely sons of bipolar energy.Clamping limb as another only exemplary example, such as clamping limb (144) may include using In one extremely sub single electrode of offer；And the ultrasound knife of such as knife (24,160) can be used as another electrode to provide for applying Another extremely son of bipolar energy.As another only exemplary example, end effector can only include an electrode (for example, all As clamping limb (144) clamping limb in or in the ultrasound knife of such as knife (24,160)), and conventional ground mat can be fixed to and suffer from Person is to provide another electrode so that end effector can be operated so that monopolar energy is applied to tissue.With reference to teaching herein Content, other adoptable suitable forms of RF electrosurgeries power train (260) will be for the ordinary skill in the art Obviously.

This exemplary sensor (262) can be operable to sense to hold by the end of instrument associated with system (250) The state for the tissue that row device is engaging.Specifically, sensor (262) can be operable to sense to one or more organization factors, It is associated with as shown in Figure 5 and line (204) as described above suitable that one or more organization factors will indicate that tissue has reached Work as seal temperature.Only by way of example, sensor (262) may include conventional temperature sensor.Only illustrative show as another Example, sensor (262) may include that (for example, saying in a way, the impedance instruction tissue of tissue reaches appropriate temperature to impedance transducer Degree otherwise reaches sealing state).As another only exemplary example, sensor (262) may include positive temperature coefficient (PTC) thermal resistor.With reference to teaching herein content, other adoptable suitable forms of sensor (262) are for ability It will be apparent for the those of ordinary skill in domain.It will also be understood that sensor (262) may be incorporated into and system (250) phase In the end effector of associated instrument (for example, in clamping limb of such as clamping limb (144)) so that sensor (262) can It is in direct contact the tissue engaged by end effector.In some patterns of system (250), sensor (262) is saved.

Following example includes the various end effector configurations that can be incorporated into system (250), and can pass through system (250) the various control algolithms executed.In addition to have the function of features described below, configuration and other than, following example can also have There are any one of various features, configuration and/or the function instructed in following patent：On March 4th, 2014 is issued entitled The United States Patent (USP) 8 of " Ultrasonic Electrosurgical Instruments ", 663,220, the disclosure of which It is herein incorporated by reference；Entitled " the Ultrasonic Surgical Instrument that on May 21st, 2015 announces The U.S. of with Electrosurgical Feature " announces 2015/0141981, and the disclosure of which is with the side of reference Formula is incorporated herein；And/or entitled " the End Effector for Instrument with that on December 11st, 2015 submits The U.S. Patent application 62/265,611 of Ultrasonic and Electrosurgical Features ", the disclosure of the patent Content is herein incorporated by reference.Following teachings can be combined with the teachings of those bibliography (and/or with this Text citation other bibliography teachings combination) various suitable modes for those of ordinary skill in the art and Speech will be apparent.

A. the exemplary end effector of the clamping limb with electrode pair

Fig. 7-Fig. 8 shows that exemplary end effector (300), exemplary end effector (300) may be incorporated into instrument (100) end effector (140) is replaced in, in order to provide the function of above system (250).End effector (340) includes folder Gripping arm (330) and ultrasound knife (320).End effector (340) is located at the distal end of shaft assembly (310).Shaft assembly (310) Including outer tube (312) and inner tube (314).Clamping limb (330) with can pivotably with outer tube (312) and also with inner tube (314) couple so that clamping limb (330) is configured in response to the relative movement between pipe (312,314), direction and remote It is pivoted from knife (320).Therefore, clamping limb (330) is pivotable just as above-mentioned clamping limb (144).In some patterns, outside (312) are managed to translate, and inner tube (314) remains stationary, in order to provide the pivot movement of clamping limb (330).In some other patterns In, inner tube (314) translation, and outer tube (312) remains stationary, in order to provide the pivot movement of clamping limb (330).It should also be as managing Solution, clamping limb (330) and the connection managed between (312,314) can be reversed so that main pivot is in inner tube (314) rather than outside It manages on (312).

This exemplary knife (320) configuration and operation just as above-mentioned knife (24,160).Alternatively, knife (320) can have Any other suitable configuration.It should be appreciated that in the context of above system (250), knife (320) is used as acoustics power train (258) a part.

This exemplary clamping limb (330) is substantially similar to above-mentioned clamping limb (144).Specifically, clamping limb (330) includes Arm body (332) is clamped and is fixed to the gripper pad (334) of clamping arm body (332) by guide rail (350).Only with the side of citing Formula, gripper pad (334) can be formed by polytetrafluoroethylene (PTFE) (PTFE) material and/or any other suitable material.With clamping limb (144) Difference, the exemplary clamping limb (330) further include a pair of electrodes (336,338) and sensor (340).In this example, electrode (336,338) are configured to provide for bipolar RF electrosurgical energy to be applied to the group contacted with electrode (336,338) Antipode knitted.In some other patterns, two electrodes (336,338) provide an extremely son, and knife (320) offer is used for Bipolar RF electrosurgical energy is applied to the another extremely sub of the tissue contacted with electrode (336,338) and knife (320).Any In the case of, it should be understood that the material for forming gripper pad (334) can have electrical insulative properties to prevent between electrode (336,338) Short circuit.It will also be understood that in the context of above system, electrode (336,338) is used as RF electrosurgeries power train (260) A part.

In this example, electrode (336,338) extends along the overall length of gripper pad (334), and is located in gripper pad (334) at lateral outermost regions.In some select pattern else, one or two of electrode (336,338) is from Fig. 7-Fig. 8 Shown in position position laterally inward so that a part for gripper pad (334) is laterally outwardly positioned from electrode (336,338). It will also be understood that three or more electrodes may be provided on gripper pad (334).In some patterns, central electrode is along folder At least part for holding the length of pad (334) is longitudinally extended, lateral placed in the middle relative to gripper pad (334), and relative to clamping Pad the tissue contacting surface recess of (334).Such positioning of electrode may make electrode that can contact tissue and cannot contact knife (320).Such recess of electrode can also be applied to the more than one electrode in gripper pad (334), and be not necessarily limited to single Central electrode.With reference to teaching herein content, other suitable configurations and arrangement of electrode (336,338) are for the general of this field It will be apparent for logical technical staff.

This exemplary sensor (340) is located at the distal end of end effector (300), and is laterally located in electricity Between pole (336,338).The position is only an exemplary example.With reference to teaching herein content, sensor (340) other Suitable position will be obvious to those of ordinary skill in the art.It is also understood that, if it is desired, end Actuator (300) may include two or more sensors (340).

This exemplary sensor (340) can be operable to sense to just be clamped the state of the tissue of pad (334) engagement.Specifically Ground, sensor (340) can be operable to sense to one or more organization factors, and one or more organization factors will indicate tissue Through reaching appropriate seal temperature associated with as shown in Figure 5 and line (204) as described above.Only by way of example, it senses Device (340) may include conventional temperature sensor.As another only exemplary example, sensor (340) may include impedance transducer (for example, saying in a way, the impedance instruction tissue of tissue reaches proper temperature or otherwise reaches sealing state).Make For another only exemplary example, sensor (340) may include positive temperature coefficient (PTC) thermal resistor.It is only illustrated as another Property example, sensor (340) may include the optical sensor that the state of tissue can be determined based on the optical sensing of tissue.Ginseng Examine teaching herein content, other adoptable suitable forms of sensor (340) for those of ordinary skill in the art and Speech will be apparent.It should be appreciated that in the context of above system (250), sensor (340) is used for sensor (262) purpose.

As shown in figure 8, end effector (300) can be used for being clamped in the tissue between clamping limb (330) and knife (320) (T₁、T₂).Although end effector (300) is illustrated as that two layers of tissue (T is clamped₁、T₂), but it is to be understood that end effector (300) some uses may include that a layer tissue (T is only clamped₁、T₂).In either case, end effector (300) can quilt It enables with only seal tissue (T₁、T₂), or cutting and seal tissue (T₁、T₂).When end effector (300) is activated to apply When RF electrosurgical energies, RF electrosurgical energies can flow through the tissue (T being located between electrode (336,338)₁、T₂).In addition or In alternative arrangement, when end effector (300) is activated to apply RF electrosurgical energies, RF electrosurgical energies can flow through positioning Tissue (T between electrode (336,338) and knife (320)₁、T₂).When end effector (300) is activated to apply ultrasonic energy When amount, ultrasonic energy is applied to the region for the tissue being clamped between clamping limb (330) and knife (320) by knife (320).It is such as following In greater detail, end effector (300) can singly or simultaneously apply RF electrosurgical energies and ultrasonic energy together in order Amount.In either case, control module (256) can determine for applying the appropriate of RF electrosurgical energies and/or ultrasonic energy Algorithm.

When RF electrosurgical energies and/or ultrasonic energy are applied to tissue (T by end effector (300)₁、T₂) when, sensor (340) it can continuously detect and tissue (T₁、T₂) associated one or more situations, and provide data to control module (256).Control module (256) can be using the data as being used to determine whether and how by RF electrosurgical energies and/or ultrasound Energy is applied to tissue (T₁、T₂) control algolithm because usually handling.The various of control algolithm are described in more detail below to show Example, and teaching herein content is referred to, other examples of control algolithm will be aobvious for the ordinary skill in the art And it is clear to.

In some patterns, electrode (336,338) includes ptc material.In some such patterns, electrode (336,338) It provides with tissue (T₁、T₂) temperature increase and increased resistance value.In some such patterns, with electrode (336,338) Electrical response in tissue (T₁、T₂) temperature increase and increases, by electrode (336,338) provide RF electrosurgical energies decrease, Once organizing (T₁、T₂) temperature be more than threshold value, RF electrosurgical energies may even stop.Therefore, because ptc material is to tissue (T₁、T₂) environment sensitive and be based on tissue (T₁、T₂) situation effectively change RF electrosurgical energies to tissue (T₁、T₂) it is defeated It send, so in some sense, the ptc material of electrode (336,338) can be used as sensor (340) other than being used as electrode. Of course, if required, electrode (336,338) is not necessarily required to include ptc material.

For example, in some other patterns, electrode (336,338) does not include ptc material, but ptc material is for sensing In device (340).In this type formula, the resistance value for forming the ptc material of sensor (340) may be in response to tissue (T₁、T₂) temperature Degree increases and changes, and control module (256) may be in response to be formed the resistance value increase of the ptc material of sensor (340), hold Row control algolithm is to reduce the RF energy conveyed by electrode (336,338).As another only exemplary example, end effector (300) it may include two discrete, spaced apart sensors (340), each sensor (340) includes ptc material.At some this In class pattern, control module (256) can be monitored by the tissue contacted by sensor (340) from a sensor (340) to separately The resistance value of the ptc material of one sensor (340).As only being illustrated using two the another of sensor (340) in this way Property modification, a sensor (340) may include ptc material, and another sensor (340) may include not by end effector (300) the non-ptc material of conduction that the temperature encountered during normal operating influences.With reference to teaching herein content, other are suitable Modification will be obvious to those of ordinary skill in the art.

B. the exemplary end effector of the clamping limb with single electrode

Fig. 9-Figure 10 shows that another exemplary end effector (400), end effector (400) may be incorporated into instrument (100) end effector (140) is replaced in, in order to provide the function of above system (250).End effector (440) includes folder Gripping arm (430) and ultrasound knife (420).End effector (440) is located at the distal end of shaft assembly (410).Shaft assembly (410) Including outer tube (412) and inner tube (414).Clamping limb (430) with can pivotably with outer tube (412) and also with inner tube (414) couple so that clamping limb (430) is configured in response to the relative movement between pipe (412,414), direction and remote It is pivoted from knife (420).Therefore, clamping limb (430) is pivotable just as above-mentioned clamping limb (144).In some patterns, outside (412) are managed to translate, and inner tube (414) remains stationary, in order to provide the pivot movement of clamping limb (430).In some other patterns In, inner tube (414) translation, and outer tube (412) remains stationary, in order to provide the pivot movement of clamping limb (430).

This exemplary knife (420) configuration and operation just as above-mentioned knife (24,160).Alternatively, knife (420) can have Any other suitable configuration.It should be appreciated that in the context of above system (250), knife (420) is used as acoustics power train (258) a part.

This exemplary clamping limb (430) is substantially similar to above-mentioned clamping limb (144).Specifically, clamping limb (430) includes Arm body (432) is clamped and is fixed to the gripper pad (434) of clamping arm body (432) by guide rail (450).Only with the side of citing Formula, gripper pad (434) can be formed by polytetrafluoroethylene (PTFE) (PTFE) material and/or any other suitable material.With clamping limb (144) Difference, which further includes electrode (436) and sensor (440).In this example, electrode (436) by with It is extremely sub to be set to one be capable of providing for applying bipolar RF electrosurgical energy, and knife (420) is provided for bipolar RF electricity is outer Section's energy is applied to the another extremely sub of the tissue of contact electrode (436) and knife (420).It should be appreciated that above and below above system Wen Zhong, electrode (436) and knife (420) are used as a part for RF electrosurgeries power train (260) together.

In this example, electrode (436) limits " u "-shaped shape, and along the quite big portion of the overall length of gripper pad (434) Divide and extends.In addition, electrode (436) is inwardly positioned from the outermost regions of gripper pad (434).In some select pattern else, electrode (436) extend along the outermost regions of gripper pad (434).As another only exemplary example, electrode (436) can be across clamping The overall with for padding (434) extends.With reference to teaching herein content, other suitable configurations and arrangement of electrode (436) are for ability It will be apparent for the those of ordinary skill in domain.

This exemplary sensor (440) is located at the distal end of end effector (400), and is only located at electrode (436) distal side.The position is only an exemplary example.With reference to teaching herein content, other of sensor (440) are suitable Position will be obvious to those of ordinary skill in the art.It is also understood that, if it is desired, end executes Device (400) may include two or more sensors (440).

This exemplary sensor (440) can be operable to sense to just be clamped the state of the tissue of pad (434) engagement.Specifically Ground, sensor (440) can be operable to sense to one or more organization factors, and one or more organization factors will indicate tissue Through reaching appropriate seal temperature associated with as shown in Figure 5 and line (204) as described above.Only by way of example, it senses Device (440) may include conventional temperature sensor.As another only exemplary example, sensor (440) may include impedance transducer (for example, saying in a way, the impedance instruction tissue of tissue reaches proper temperature or otherwise reaches sealing state).Make For another only exemplary example, sensor (440) may include positive temperature coefficient (PTC) thermal resistor.With reference to teaching herein Content, other adoptable suitable forms of sensor (440) will be aobvious and easy for the ordinary skill in the art See.It should be appreciated that in the context of above system (250), sensor (440) is used for the purpose of sensor (262).

As shown in Figure 10, end effector (400) can be used for being clamped in the tissue between clamping limb (430) and knife (420) (T₁、T₂).Although end effector (400) is illustrated as that two layers of tissue (T is clamped₁、T₂), but it is to be understood that end effector (400) some uses may include that a layer tissue (T is only clamped₁、T₂).In either case, end effector (400) can quilt It enables with only seal tissue (T₁、T₂), or cutting and seal tissue (T₁、T₂).When end effector (400) is activated to apply When RF electrosurgical energies, RF electrosurgical energies can flow through the tissue (T being located between electrode (436) and knife (420)₁、T₂).When When end effector (400) is activated to apply ultrasonic energy, ultrasonic energy is applied to by knife (420) is clamped in clamping limb (430) region of the tissue between knife (420).As described in more detail below, end effector (400) can in order individually Ground applies RF electrosurgical energies and ultrasonic energy together simultaneously.In either case, control module (256), which can determine, is used for Apply RF electrosurgical energies and/or the appropriate algorithm of ultrasonic energy.

When RF electrosurgical energies and/or ultrasonic energy are applied to tissue (T by end effector (400)₁、T₂) when, sensor (440) it can continuously detect and tissue (T₁、T₂) associated one or more situations, and provide data to control module (256).Control module (256) can be using the data as being used to determine whether and how by RF electrosurgical energies and/or ultrasound Energy is applied to tissue (T₁、T₂) control algolithm because usually handling.The various of control algolithm are described in more detail below to show Example, and teaching herein content is referred to, other examples of control algolithm will be aobvious for the ordinary skill in the art And it is clear to.

In some patterns, electrode (436) includes ptc material.In some such patterns, electrode (436) provide with Organize (T₁、T₂) temperature increase and increased resistance value.In some such patterns, with electrode (436) electrical response in Organize (T₁、T₂) temperature increase and increases, by electrode (436) provide RF electrosurgical energies weaken, once organize (T₁、T₂) Temperature be more than threshold value, RF electrosurgical energies may even stop.Therefore, because ptc material is to tissue (T₁、T₂) situation it is quick Feel and is based on tissue (T₁、T₂) situation effectively change RF electrosurgical energies to tissue (T₁、T₂) conveying, so at certain In meaning, the ptc material of electrode (436) can be used as sensor (440) other than being used as electrode.Of course, if required, electric Pole (436) is not necessarily required to include ptc material.

For example, in some other patterns, electrode (436) does not include ptc material, but ptc material is used for sensor (440) in.In this type formula, the resistance value for forming the ptc material of sensor (440) may be in response to tissue (T₁、T₂) temperature Increase and change, and control module (256) may be in response to be formed the resistance value increase of the ptc material of sensor (440), execute Control algolithm is to reduce the RF energy by electrode (436) and knife (420) conveying.As another only exemplary example, end is held Row device (400) may include two discrete, spaced apart sensors (440), and each sensor (440) includes ptc material.One In a little such patterns, control module (256) can be monitored by the tissue contacted by sensor (440) from a sensor (440) To the resistance value of the ptc material of another sensor (440).As use in this way two sensors (440) it is another only Illustrative modification, a sensor (440) may include ptc material, and another sensor (440) may include not held by end The non-ptc material of conduction that the temperature encountered during the normal operating of row device (400) influences.With reference to teaching herein content, other Suitable modification will be obvious to those of ordinary skill in the art.

C. exemplary control algorithm

Following example includes that the control logic in control module (256) that can be by residing in system (250) is performed Various control algolithms.It is calculated it will also be understood that any of above-mentioned end effector (300,400) can be used for executing these controls Method.In addition it or in alternative arrangement, is such as announced described in 2015/0141981 in United States Patent (USP) 8,663,220 and/or the U.S. Those of end effector can be used for executing these control algolithms.With reference to teaching herein content, it can be used for executing these controls Other suitable end effectors of algorithm processed will be obvious to those of ordinary skill in the art.It should manage Solution, operator one activates button (126), while tissue (T is clamped with end effector (300,400)₁、T₂), calculation described below Each of method can start.

Figure 11 shows the curve graph (500) for describing algorithm, and end effector (300,400) can be in a particular order whereby RF electrosurgical energies and ultrasonic energy are applied to tissue (T with combination₁、T₂).Figure 12 is shown in executing curve graph (500) It is clamped in the time course between clamping limb (330,430) and knife (320,420) Nei and draws in tissue during the algorithm of description The curve graph (600) of tissue temperature (602).When executing this exemplary algorithm, control module (256) enables end execution first Device (300,400) by RF electrosurgical energies to be applied to tissue.In curve graph (500), RF electrosurgical energies are by having interval The line (502) for the circle opened indicates.As shown in figure 12, which provides increasing rapidly for tissue temperature (602), causes Organize (T₁、T₂) start relatively quickly to seal after control algolithm is first carried out.Line (612) indicates tissue (T₁、T₂) will open Begin the temperature levels sealed.Similarly, line (606) indicates tissue (T₁、T₂) start the time sealed.It should be from the curve graph of Fig. 5 (200) comparison between the curve graph of Figure 12 (600) understands, when process starts with RF electrosurgical energies, tissue (T₁、T₂) will more rapidly start to seal.

In this example, control algolithm include control module (256) enable end effector (300,400) with and meanwhile apply The overlapping period of RF electrosurgical energies and ultrasonic energy.In the curve graph (500) of Figure 11, this is happened at is indicated by line (506) At the time of.In curve graph (500), ultrasonic energy is indicated by the line (504) with x spaced apart.In the curve graph of Figure 12 (600) in, this is happened at the time of indicated by line (604).It is thus to be understood that at the time of line (506,604) indicates identical.It should Moment and tissue (T₁、T₂) associated up to slightly below the temperature levels (610) for sealing the temperature levels (612) actually started.One Denier sealing actually starts, and control module (256) just stops applying RF electrosurgical energies via end effector (300,400), makes It obtains end effector (300,400) and only applies ultrasonic energy.The transformation is happened at the line in the curve graph (500) by Figure 11 (508) at the time of expression.It is thus to be understood that at the time of line (508,606) indicates identical.

At the time of being indicated by line (506,604) at the time of expression by line (508,606) between power mode it is Chong Die During period, the power level of RF electrosurgical energies can gradually decrease to zero.Alternatively, the power level of RF electrosurgical energies exists It can during power mode overlapping period between at the time of expression at the time of expression by line (506,604) and by line (508,606) It is constant.Power mode between at the time of no matter expression at the time of being indicated by line (506,604) and by line (508,606) The power level of RF electrosurgical energies is to maintain constant or changes during overlapping period, and the power level of ultrasonic energy can be gradual Increase, or can be enabled immediately with predetermined power level.When control module (256) stops via end effector (300,400) When applying RF electrosurgical energies, (T is organized₁、T₂) temperature can be imparted into relying on via end effector (300,400) Organize (T₁、T₂) the speed of amount of ultrasonic energy continue to increase.

During period between should be appreciated that at the time of being indicated by line (606,608), (T is organized₁、T₂) will be by actively Sealing.As shown in figure 12, tissue temperature (602) continues during the duration indicated by the spacing between line (606,608) Increase.However, increased speed is less than the increased speed encountered during warm-up phase during the duration, rank is preheated Before section is happened at the time of expression by line (604) and it is up at the time of indicated by line (604).In other words, with by line (604) tissue before at the time of expression and up to encountered at the time of indicated by line (604), which heats, to be compared, by line (606, 608) during the duration that the spacing between indicates, tissue heating is more progressive.In some other patterns, by line (606, 608) during the period that the spacing between indicates, at horizontal (612) associated with sealing, tissue temperature (602) is kept Substantial constant.In some such patterns, the defeated of the ultrasonic power for passing through knife (320,420) is adjusted in control module (256) It send, to provide the substantially constant of tissue temperature (602) during the period.In some such patterns, control module 256 By the feedback from sensor (340,440), to adjust the conveying of the ultrasonic power by knife (320,420), so as to Basic constancy is provided in tissue temperature (602).

Once organizing (T₁、T₂) be suitably sealed, control module (256) can go to enable ultrasonic power, this can lead Tissue temperature (602) is caused to reduce.At the time of indicating that ultrasonic power is gone to enable by the line (608) in Figure 12.In some patterns, This of ultrasonic power is automatically provided by control module (256) to go to enable.Only by way of example, control module (256) can respond In the data from sensor (340,440), automatically go to enable ultrasonic power.In addition or in alternative arrangement, control module (256) data that may be in response to come self-timer and/or some other components go to enable ultrasonic power automatically.As it is another only Illustrative alternative arrangement, ultrasonic power (such as can enable button (126) by release) manually by operator and go to enable.

It will also be understood that the data in response to coming from sensor (340,440), control module (256) can by line (506, 508) power mode transformation is automatically provided at the time of expression.For example, when sensor (340,440) detects tissue temperature (602) When having surmounted first threshold horizontal (610), control module (256) can be by enabling ultrasonic energy while maintaining RF electricity outer automatically The enabling of section's energy makes a response.When sensor (340,440) detects that tissue temperature (602) has reached and tissue encapsulation phase When associated level (612), control module (256) can be by going to enable RF electrosurgical energies while maintaining ultrasonic energy automatically Enabling makes a response.In the pattern that electrode (336,338,436) includes ptc material, by the change for the resistance that ptc material provides It can influence to go to enable by the RF electrosurgical energies of end effector (300,400).In this type formula, control module (256) any kind of switching need not be provided to go to enable RF electrosurgical energies.

In addition to or substitute based on from sensor (340,440) data, by control module (256) provide power mode Transformation can be based on elapsed time.For example, control module (256) can perform control algolithm, which makes a reservation in certain Only RF energy is provided to tissue via end effector (300,400), in duration then in follow-up predetermined lasting time It is interior to provide the combination of RF energy and ultrasonic energy to tissue via end effector (300,400), then executed via end Device (300,400) only provides ultrasonic energy to tissue.As another only exemplary example, the executable control of control module (256) Algorithm processed, the control algolithm only provide RF energy via end effector (300,400) in certain predetermined lasting time To tissue, then only ultrasonic energy is provided to tissue via end effector (300,400).Accordingly, it should be understood that at some In pattern, sensor (340,440) can be removed.As another only illustrative modification, control module (256), which can rely on, carrys out autobiography Organization factors and the combination of time situation are used as and are held by the combination of the data of sensor (340,440) and the data for carrying out self-timer Factor in row control algolithm by end effector (300,400) to provide power mode transformation.

Above-mentioned power mode transformation can occur when operator continues actuating button (126) so that operator need not hold Any individual action of row, changes in order to provide these power modes.In some patterns, control module (256) can trigger one The audible feedback and/or visual feedback of kind or diversified forms, to indicate that end effector (300,400) is providing to operator Power mode changes.With reference to teaching herein content, operator can receive the various suitable modes of the feedback for this field It will be apparent for those of ordinary skill.

Figure 13 shows the curve graph (700) for describing another algorithm, and end effector (300,400) can be specific whereby RF electrosurgical energies and ultrasonic energy are applied to tissue (T by sequence and combination₁、T₂).When executing this exemplary algorithm, control Module (256) enables end effector (300,400) so that RF electrosurgical energies are applied to tissue first.In curve graph (700) In, RF electrosurgical energies are indicated by the line (702) with circle spaced apart.It is as mentioned above and as shown in figure 12, the RF Electrosurgical energy provides increasing rapidly for tissue temperature (602), leads to tissue (T₁、T₂) opened after control algolithm is first carried out Beginning relatively quickly seals.So it is same, compared with only ultrasonic energy, when process starts with RF electrosurgical energies, Organize (T₁、T₂) more rapidly seal beginning.

Different from algorithm shown in the curve graph (500) of Figure 11, algorithm shown in curve graph (700) is provided from RF electricity Thixotroping of the electrosurgical energy to ultrasonic energy so that there is no the overlapping periods for applying RF electrosurgical energies and ultrasonic energy simultaneously. In curve graph (700), ultrasonic energy is indicated by the line (704) with x spaced apart.By in the curve graph (700) of Figure 13 At the time of line (706) indicates that power mode transformation occurs.In some patterns, by the line in the curve graph (700) of Figure 13 (706) it is overlapped at the time of the moment indicated can indicate with the line (604) in the curve graph (600) by Figure 12.In other words, one Denier tissue temperature (602) is horizontal (610) by the first threshold for being slightly below the practical level (612) started of tissue encapsulation, control Module (256) can be from only RF electrosurgical energies thixotroping to only ultrasonic energy.In some other patterns, by the curve graph of Figure 13 (700) line (706) in overlaps at the time of being indicated with the line (606) in the curve graph (600) by Figure 12 at the time of expression.It changes Word says that, once tissue temperature (602) reaches the practical level (612) started of tissue encapsulation, control module (256) can be from only The thixotroping of RF electrosurgical energies is to only ultrasonic energy.

Figure 14 shows the curve graph (800) for describing another algorithm, and end effector (300,400) can be specific whereby RF electrosurgical energies and ultrasonic energy are applied to tissue (T by sequence and combination₁、T₂).When executing this exemplary algorithm, control Module (256) enables end effector (300,400) so that RF electrosurgical energies are applied to tissue first.In curve graph (800) In, RF electrosurgical energies are indicated by the line (802) with circle spaced apart.It is as mentioned above and as shown in figure 12, the RF Electrosurgical energy provides increasing rapidly for tissue temperature (602), leads to tissue (T₁、T₂) opened after control algolithm is first carried out Beginning relatively quickly seals.So it is same, compared with only ultrasonic energy, when process starts with RF electrosurgical energies, Organize (T₁、T₂) more rapidly seal beginning.

Different from algorithm shown in the curve graph (500) of Figure 11, it is outer that algorithm shown in curve graph (800) provides RF electricity The continued combination of section's energy and ultrasonic energy.In curve graph (800), ultrasonic energy is indicated by the line (804) with x spaced apart Amount.At the time of indicating that power mode transformation occurs by the line (806) in the curve graph (800) of Figure 14.In some patterns, by The moment that line (806) in the curve graph (800) of Figure 14 indicates can be with line (604) table in the curve graph (600) by Figure 12 It is overlapped at the time of showing.In other words, once tissue temperature (602) is by being slightly below the practical level (612) started of tissue encapsulation First threshold it is horizontal (610), control module (256) can be from only RF electrosurgical energies thixotroping to RF electrosurgical energies and ultrasound The combination of energy.In some other patterns, by the curve graph (800) of Figure 14 line (806) indicate at the time of can with by scheming Line (606) in 12 curve graph (600) overlaps at the time of expression.In other words, once to reach tissue close for tissue temperature (602) The level (612) actually started is sealed, control module (256) can be from only RF electrosurgical energies thixotroping to RF electrosurgical energies and super The combination of acoustic energy.

As mentioned above, at the time of being indicated by line (606,608) between period during, organize (T₁、T₂) will By realizing active sealing.Also as mentioned above and as shown in figure 12, during the period, in level associated with sealing (612) at, tissue temperature (602) keeps substantial constant.In some patterns, control module (256) is adjustable to pass through end The combination transfer of the RF electrosurgical energies and ultrasonic power of actuator (300,400), to provide tissue temperature during the period Spend the constancy of (602).In some such patterns, control module (256) relies on the feedback from sensor (340,440), To adjust the combination transfer of RF electrosurgical energies and ultrasonic power by end effector (300,400), in order to provide group Knit the constancy of temperature (602).Only by way of example, the data from sensor (340,440), control module are based on (256) power level of RF electrosurgical energies is can be improved or reduced, and/or increases or decreases and is indicated by line (606,608) At the time of between period during ultrasonic power level, in order to provide the constancy of tissue temperature (602).As it is another only Exemplary example, control module (256) can determine at the time of being indicated by line (606,608) between period during it is specific Whether RF electrosurgical energies or ultrasonic energy are optimal power modes in moment, and based on from sensor (340, 440) data correspondingly switch between these power modes.

IV. example combinations

Following embodiment is related to the various non-exclusive modes that teaching herein content can be combined or apply.It should manage Solution, following embodiment be not intended to limit can the application or the application it is follow-up present a paper in appointing of presenting any time The coverage area of what claim.It is not intended to carry out disclaimer.Following embodiment is provided merely for the sake of illustrative purpose.If Expect, the various teachings of this paper can be arranged and applied with a variety of other manners.It is also contemplated that some modifications can save Involved certain features in embodiment below.Thus, any one of aspect or feature for being set forth below should not be worked as Making decision property, unless being in addition for example explicitly indicated so on the date later by the successor of inventor or concern inventor.Such as Fruit the application or with any claim of the relevant middle presentation of subsequently presenting a paper of the application include those of be set forth below it is special Supplementary features except sign, then those supplementary features should not be assumed to be added due to any reason relevant with patentability.

Embodiment 1

A kind of equipment, including：(a) main body；(b) shaft assembly, Middle shaft assembly extend from main body towards distal side, Middle shaft assembly Including acoustic waveguide, wherein waveguide is configured to couple with ultrasound transducer acoustic；(c) end effector, medial end portions are held Row device includes：(i) ultrasound knife, ultrasound knife and waveguide acoustic connection, (ii) clamping limb, wherein clamping limb can operate so as to organize The ultrasound knife compression is abutted against, (iii) electrode, wherein electrode can be operated so that radio frequency (RF) electrosurgical energy is applied to group It knits, and (iv) sensor, wherein sensor can be operable to sense to the situation of the tissue contacted by end effector；And (d) control module, wherein control module can be operated based on the data from sensor to control through the super of end effector The conveying of acoustical power and RF electrosurgical energies.

Embodiment 2

According to equipment described in embodiment 1, wherein control module is configured as：(i) first, end effector is enabled with only RF electrosurgical energies are applied to the tissue being trapped between clamping limb and ultrasound knife, and (ii) second, are being applied After RF electrosurgical energies, enables end effector and be trapped between clamping limb and ultrasound knife so that ultrasonic energy to be applied to Tissue.

Embodiment 3

According to the equipment described in embodiment 2, wherein control module is configured to based on the data from sensor, from It enables end effector and is automatically changeb to so that RF electrosurgical energies are only applied to tissue and enable end effector with by ultrasonic energy Amount is applied to tissue.

Embodiment 4

According to equipment described in embodiment 3, wherein control module is configured to based on the key group from sensor The data for having reached certain temperature are knitted, are automatically changeb to from end effector is enabled with RF electrosurgical energies are only applied to tissue End effector is enabled so that ultrasonic energy is applied to tissue.

Embodiment 5

It is configured to controlling according to any one of embodiment 2 to 4 or the multinomial equipment, wherein control module Module enables end effector to be automatically stopped end effector when ultrasonic energy is applied to tissue only by RF electrosurgical energies It is applied to the enabling of tissue so that end effector by RF electrosurgical energies after being only applied to tissue, only by ultrasonic energy It is applied to tissue.

Embodiment 6

According to equipment described in embodiment 1, wherein control module is configured to：(i) first, enable end effector RF electrosurgical energies are only applied to the tissue being trapped between clamping limb and ultrasound knife, and (ii) second, After applying RF electrosurgical energies, enables end effector and be caught so that the combination of RF electrosurgical energies and ultrasonic energy to be applied to Obtain the tissue between clamping limb and ultrasound knife.

Embodiment 7

According to the equipment described in embodiment 6, wherein control module is configured to based on the data from sensor, from Enable end effector with only by RF electrosurgical energies be applied to tissue be automatically changeb to enable end effector with will RF electricity it is outer The combination of section's energy and ultrasonic energy is applied to tissue.

Embodiment 8

According to any one of embodiment 6 to 7 or the multinomial equipment, wherein be further configured to can for control module：The Three, after having applied the combination of RF electrosurgical energies and ultrasonic energy, only ultrasonic energy is applied to and is trapped in clamping Tissue between arm and ultrasound knife.

Embodiment 9

According to the equipment described in embodiment 8, wherein control module is further configured to that ultrasonic energy and RF electricity can be being applied It is adjusted between electrosurgical energy, in order to provide substantially invariable tissue temperature.

Embodiment 10

It is integrated into clamping limb according to any one of embodiment 1 to 9 or the multinomial equipment, wherein electrode.

Embodiment 11

It is configured to according to any one of embodiment 1 to 10 or the multinomial equipment, wherein electrode and ultrasound knife Cooperation by bipolar RF electrosurgical energy to be applied to tissue.

Embodiment 12

It is integrated into clamping limb according to any one of embodiment 1 to 11 or the multinomial equipment, wherein sensor.

Embodiment 13

According to any one of embodiment 1 to 12 or the multinomial equipment, wherein sensor includes temperature sensor.

Embodiment 14

According to any one of embodiment 1 to 13 or the multinomial equipment, wherein sensor includes impedance transducer.

Embodiment 15

According to any one of embodiment 1 to 14 or the multinomial equipment, wherein sensor includes positive temperature coefficient (PTC) Thermal resistor.

Embodiment 16

A kind of equipment, including：(a) main body；(b) shaft assembly, Middle shaft assembly extend from main body towards distal side, Middle shaft assembly Including acoustic waveguide, wherein waveguide is configured to couple with ultrasound transducer acoustic；(c) end effector, medial end portions are held Row device includes：(i) ultrasound knife, ultrasound knife and waveguide acoustic connection, and (ii) clamping limb, wherein clamping limb can operate so that Tissue abuts against the ultrasound knife compression, and wherein clamping limb and ultrasound knife can be operated to cooperate so that bipolar radio frequency (RF) electricity is outer Section's energy is applied to tissue；(d) sensor, wherein sensor can be operable to sense to the shape of the tissue contacted by end effector Condition；And (e) control module, wherein control module can operate with：(i) end effector is enabled in warm-up phase RF electricity Electrosurgical energy preheats tissue；(ii) end effector is enabled in sealing stage ultrasonic energy seal tissue, and (iii) base In the data from sensor, the sealing stage is automatically changeb to from warm-up phase.

Embodiment 17

A kind of method of seal tissue, including：(a) radio frequency (RF) electrosurgical energy is applied to tissue to preheating group It knits；(b) situation associated with the temperature of tissue is sensed, the action that RF electrosurgical energies are applied to tissue is performed simultaneously；(c) The temperature of detection instruction tissue has reached the situation of predeterminated level；And ultrasonic energy (d) is applied to tissue with sealing group It knits, wherein the action for the situation that the temperature based on detection instruction tissue has reached predeterminated level is initiated ultrasonic energy being applied to The action of tissue.

Embodiment 18

Further include indicating that the temperature of tissue has reached predeterminated level in response to detection according to the method described in embodiment 17 Situation action, stop for radio frequency (RF) electrosurgical energy being applied to the action of tissue.

Embodiment 19

According to the method described in embodiment 17, wherein ultrasonic energy is applied to tissue with the action of seal tissue executing Period continues to execute the action for applying radio frequency (RF) electrosurgical energy.

Embodiment 20

According to the method described in embodiment 17, wherein ultrasonic energy is applied to tissue with the action of seal tissue executing In the first time period of period, the action for applying radio frequency (RF) electrosurgical energy is continued to execute, wherein executing ultrasonic energy Tissue is applied to so that during the second time period during the action of seal tissue, the action for applying radio frequency (RF) electrosurgical energy stops Only.

Embodiment 21

A kind of method of seal tissue, including：(a) radio frequency (RF) electrosurgical energy is applied to group via end effector It knits, to preheat tissue；And ultrasonic energy (b) is applied to preheated tissue automatically via end effector, to close The preheated tissue of envelope, wherein being initiated via end when passing through predetermined amount of time after the action for initiating to apply RF electrosurgical energies Ultrasonic energy is applied to the action of preheated tissue by portion's actuator automatically.

Embodiment 22

Further include stopping applying RF electrosurgical energies when by predetermined amount of time according to the method described in embodiment 21 To the action of tissue.

V. miscellaneous

It should be appreciated that the instrument of any pattern as described herein may include in addition to or substitute various other spies of those described above Sign.Only by way of example, any instrument described herein may also comprise the various references for being disclosed in and being herein incorporated by reference One or more of various features of any one of document.It will also be understood that teaching herein content can be applied easily Any instrument described in any other bibliography recited in this paper so that teaching herein content can be easily with more Kind mode is combined with the teachings in any bibliography recited in this paper.It may be incorporated into other classes of teaching herein content The instrument of type will be obvious to those of ordinary skill in the art.

It will also be understood that herein the range of involved any value should be appreciated be include such range the upper limit and Lower limit.For example, other than the value between being included in those upper and lower bounds, it is expressed as " at about 1.0 inches and about 1.5 Inch between " range it should be appreciated that it includes about 1.0 inches and about 1.5 inches to be.

It is to be appreciated that it is said that any patent being hereby incorporated herein by, announcement or other public materials, either Full text or part are not only rushed in incorporated material with existing definition, statement or other public materials illustrated in the disclosure It is incorporated herein in prominent degree.As such, and at the necessary level, the disclosure being expressly recited herein is replaced with the side of reference Any conflict material that formula is incorporated herein.It is said that be herein incorporated by reference but with existing definition set forth herein, statement or Other conflicting any materials of public material or part thereof, will be only between incorporated material and existing public material not It generates and is incorporated under the degree of conflict.

The pattern of above-mentioned apparatus can be applied to the conventional medical treatment carried out by medical professional and operation, and application In the therapeutic treatment and operation of robot assisted.Only by way of example, the various teachings of this paper can be readily incorporated into Robotic surgical system, Intuitive Surgical Inc. (Intuitive in such as cities California Sen Niweier Surgical, Inc., of Sunnyvale, California) DAVINCI^TMSystem.Similarly, the ordinary skill of this field Personnel it will be recognized that the various teachings of this paper can easily be announced within 31st with August in 2004 it is entitled ", Robotic Surgical Tool with Ultrasound Cauterizing and Cutting Instrument) " United States Patent (USP), 6,783,524 various teachings combination, the disclosure of which are herein incorporated by reference.

Above-mentioned pattern is designed to discard after a single use or it is designed to using multiple.Any In the case of or two kinds in the case of, pattern can be repaired to be reused after use at least once.Reparation may include with Any combinations of lower step：Provision for disengagement is cleaned or is replaced later specific part, and subsequently re-assemblied.Specifically, The device of some detachable patterns, and can with any combinations come selectively replace or remove device it is any amount of specifically Part or part.When cleaning and/or replacing specific part, the device of some patterns can re-assembly at the repair facility or It is re-assemblied by operator for subsequently using before it will be performed the operation.It will be understood by those skilled in the art that device Reparation can be dismantled using multiple technologies, clean/replace and re-assembly.The use of such technology and gained Prosthetic device is within the scope of application.

Only by way of example, pattern described herein can sterilize before the surgery and/or later.In a kind of disinfection technology In, it places the device in the container such as polybag or TYVEK bag of closure and sealing.Then container and device can be placed on In the radiation field that container can be penetrated, such as γ radiation, x-ray or high energy electron.Radiation can kill thin on device and in container Bacterium.Sterilized device is then stored in sterile chamber, for using later.Can also be used it is known in the art it is any its He carries out disinfection to device at technology, which includes but not limited to β radiation or γ radiation, ethylene oxide or steam.

Various embodiments of the present invention have been shown and described, can without departing from the scope of the invention by Those skilled in the art are appropriately modified to realize the other improvement of method described herein and system.It is already mentioned above Several such possible modifications, and other modifications will be apparent for a person skilled in the art.For example, Example discussed above, embodiment, geometry, material, size, ratio, step etc., which are illustrative rather than, to be wanted It asks.Then, the scope of the present invention should consider according to following claims, and be interpreted as being not limited to specification and attached The details structurally and operationally for showing and describing in figure.

Claims

1. a kind of equipment, including：

(a) main body；

(b) shaft assembly, wherein the shaft assembly extends from the main body towards distal side, wherein the shaft assembly includes acoustic waveguide, Described in waveguide be configured to couple with ultrasound transducer acoustic；

(c) end effector, wherein the end effector includes：

(i) ultrasound knife, the ultrasound knife and the waveguide acoustic connection,

(ii) clamping limb, wherein the clamping limb can operate so as to organize to abut against the ultrasound knife compression,

(iii) electrode, wherein the electrode can be operated so that radio frequency (RF) electrosurgical energy is applied to tissue, and

(iv) sensor, wherein the sensor can be operable to sense to the situation of the tissue contacted by the end effector； With

(d) control module, wherein the control module can be operated to be passed through to control based on the data from the sensor The conveying of the ultrasonic power and RF electrosurgical energies of the end effector.

2. equipment according to claim 1, wherein the control module is configured to：

(i) first, it enables the end effector and is trapped in the clamping limb and institute to be only applied to RF electrosurgical energies The tissue between ultrasound knife is stated, and

(ii) second, after having applied the RF electrosurgical energies, the end effector is enabled to apply ultrasonic energy It is added to the tissue being trapped between the clamping limb and the ultrasound knife.

3. equipment according to claim 2, wherein the control module is configured to based on from the sensor Data, enable the end from enabling the end effector and being automatically changeb to so that RF electrosurgical energies are only applied to tissue Actuator by ultrasonic energy to be applied to tissue.

4. equipment according to claim 3, wherein the control module is configured to based on from the sensor , instruction is described organizes to have reached the data of certain temperature, from the end effector is enabled only to apply RF electrosurgical energies It is added to tissue and is automatically changeb to the enabling end effector so that ultrasonic energy is applied to tissue.

5. equipment according to claim 2, wherein the control module is configured to enable in the control module The end effector is to be automatically stopped the end effector only by RF electrosurgical energies when ultrasonic energy is applied to tissue It is applied to the enabling of tissue so that the end effector, only will be ultrasonic after RF electrosurgical energies are only applied to tissue Energy is applied to tissue.

6. equipment according to claim 1, wherein the control module is configured to：

(ii) second, after having applied the RF electrosurgical energies, the end effector is enabled with by RF electrosurgery energy The combination of amount and ultrasonic energy is applied to the tissue being trapped between the clamping limb and the ultrasound knife.

7. equipment according to claim 6, wherein the control module is configured to based on from the sensor Data, enable the end from enabling the end effector and being automatically changeb to so that RF electrosurgical energies are only applied to tissue Actuator by the combination of RF electrosurgical energies and ultrasonic energy to be applied to tissue.

8. equipment according to claim 6, wherein be further configured to can for the control module：Third is applying After the combination of the RF electrosurgical energies and ultrasonic energy, only ultrasonic energy is applied to and is trapped in the clamping limb and institute State the tissue between ultrasound knife.

9. equipment according to claim 8, wherein the control module be further configured to can apply ultrasonic energy and It is adjusted between RF electrosurgical energies, in order to provide substantially invariable tissue temperature.

10. equipment according to claim 1, wherein the electrode is integrated into the clamping limb.

11. equipment according to claim 1, wherein the electrode and the ultrasound knife are configured to cooperation with will be double Pole RF electrosurgical energies are applied to tissue.

12. equipment according to claim 1, wherein the sensor is integrated into the clamping limb.

13. equipment according to claim 1, wherein the sensor includes temperature sensor.

14. equipment according to claim 1, wherein the sensor includes impedance transducer.

15. equipment according to claim 1, wherein the sensor includes positive temperature coefficient (PTC) thermal resistor.

16. a kind of equipment, including：

(a) main body；

(c) end effector, wherein the end effector includes：

(i) ultrasound knife, the ultrasound knife and the waveguide acoustic connection, and

(ii) clamping limb, wherein the clamping limb can operate so as to organize to abut against the ultrasound knife compression, wherein the folder Gripping arm and the ultrasound knife can be operated is applied to tissue to cooperate by bipolar radio frequency (RF) electrosurgical energy；

(d) sensor, wherein the sensor can be operable to sense to the situation of the tissue contacted by the end effector；With

(e) control module, wherein the control module can operate with：

(i) end effector is enabled to preheat tissue in warm-up phase RF electrosurgical energies,

(ii) end effector is enabled to seal stage ultrasonic energy seal tissue, and

(iii) based on the data from the sensor, the sealing stage is automatically changeb to from the warm-up phase.

17. a kind of method of seal tissue, including：

(a) radio frequency (RF) electrosurgical energy is applied to tissue to preheat the tissue；

(b) associated with the temperature of tissue situation is sensed, is performed simultaneously described in being applied to RF electrosurgical energies The action of tissue；

(c) detection indicates that the temperature of the tissue has reached the situation of predeterminated level；And

(d) ultrasonic energy is applied to the tissue to seal the tissue, wherein being indicated described in the tissue based on detection Temperature has reached the action of the situation of the predeterminated level to initiate ultrasonic energy being applied to the action of the tissue.

18. further including according to the method for claim 17, indicating that the temperature of the tissue has reached in response to detection To the action of the situation of the predeterminated level, stop radio frequency (RF) electrosurgical energy being applied to the described dynamic of tissue Make.

19. according to the method for claim 17, wherein that ultrasonic energy is applied to the tissue is described to seal executing The action for applying radio frequency (RF) electrosurgical energy is continued to execute during the action of tissue.

20. according to the method for claim 17, wherein that ultrasonic energy is applied to the tissue is described to seal executing During the action of tissue, in first time period, the action for applying radio frequency (RF) electrosurgical energy is continued to execute, During executing ultrasonic energy be applied to the action of the tissue to seal the tissue, in the second time period phase Between, the action for applying radio frequency (RF) electrosurgical energy stops.

21. a kind of method of seal tissue, including：

(a) radio frequency (RF) electrosurgical energy is applied to tissue to preheat the tissue via end effector；And

(b) ultrasonic energy is applied to preheated tissue to seal preheated group automatically via the end effector It knits, wherein initiating to execute via the end when by predetermined amount of time after the action for initiating to apply RF electrosurgical energies Ultrasonic energy is applied to the action of preheated tissue by device automatically.

22. further including according to the method for claim 21, stopping RF electrosurgery energy when by the predetermined amount of time Amount is applied to the action of the tissue.